Premium
Systematic review with meta‐analysis: effects of implementing a nutrition support team for in‐hospital parenteral nutrition
Author(s) -
Eriksen Marcel Kjærsgaard,
Crooks Benjamin,
Baunwall Simon Mark Dahl,
Rud Charlotte Lock,
Lal Simon,
Hvas Christian Lodberg
Publication year - 2021
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.16530
Subject(s) - medicine , meta analysis , cochrane library , observational study , medline , parenteral nutrition , systematic review , randomized controlled trial , pediatrics , political science , law
Summary Background Nutrition support teams (NST) may improve parenteral nutrition (PN) outcomes. No previous systematic review has provided conclusive data on catheter‐related infection (CRI) occurrence after NST introduction, nor have previous studies performed meta‐analysis or graded the evidence. Aims To systematically evaluate the effects of implementing an NST for hospitalised adults on PN and compare these with standard care. Methods This was a systematic review and meta‐analysis, pre‐registered in PROSPERO (CRD42020218094). On November 24, 2020, PubMed, Web of science, Scopus, Embase, Cochrane Library, and Clinical Key were searched. Clinical trials and observational studies with a standard care comparator were included. Primary outcome was relative reduction in CRI rate. A random‐effects meta‐analysis was used to estimate effects, and evidence was rated using Cochrane and GRADE methodologies. Results Twenty‐seven studies with 8166 patients were included. Across 10 studies, NST introduction reduced the CRI rate (IRR = 0.32, 95% CI: 0.19‐0.53) with −8 (95% CI: −12 to −5) episodes per 1000 catheter days compared with standard care. Hypophosphataemia occurred less frequently (IRD = −12%, 95% CI: −24% to −1%) and 30‐day mortality decreased (IRD = −6%, 95% CI: −11% to −1%). Inappropriate PN use decreased, both judged by indication (IRD = −18%, 95% CI: −28% to −9%) and duration (IRD = −21%, 95% CI: −33% to −9%). Evidence was rated very low to moderate. Conclusions This study documents the clinical impact of introducing an NST, with moderate‐grade evidence for the reduction of CRI occurrence compared with standard care. Further, NST introduction significantly reduced metabolic complications, mortality, and inappropriate PN use.